Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy

Limited evidence exists that optimization of surgical team composition may improve effectiveness of laparoscopic donor nephrectomy (LDN). A retrospective cohort study with 541 consecutive LDNs. From 2003 to 2012, surgical team composition was gradually optimized with regard to the surgeons' experience, proficient assistance and the use of fixed teams. Multivariable analysis showed that a surgical team with an experienced surgeon had a significantly shorter operation time (OT) (-18 min, 95 % CI -28 to -9), less estimated blood loss (EBL) (-64 mL, 95 % CI -108 to -19) and shorter length of stay (LOS) (-1 day, 95 % CI -1.6 to 0). Proficient assistance was also independently associated with a shorter OT (-43 min, 95 % CI -53 to -33) and reduced EBL (-58 mL, 95 % CI -109 to -6), whereas those procedures performed by fixed teams were related to a shorter operation (-50 min, 95 % CI -59 to -43) and warm ischemia time (-1.8, 95 % CI -2.1 to -1.5), a reduced mean complication grade (-0.14 per patient, 95 % CI -0.3 to -0.02) and a shorter LOS (-1.1 day, 95 % CI -1.7 to -05). Health care costs for LDN by one staff surgeon with unproficient assistance were 7.707 Euro, whereas costs for LDN by two staff surgeons in fixed teams were 5.614 Euro. Surgical team composition has a major impact on variables that reflect the effectiveness of LDN from the donors' perspective. Health care costs are lower for LDNs performed by two experienced surgeons in fixed team composition. We advocate the use of two experienced surgeons in fixed team composition for LDN.